Provider Demographics
NPI:1073672960
Name:MASARSKY, CHARLES STEFAN (DC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:STEFAN
Last Name:MASARSKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1634
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22183-1634
Mailing Address - Country:US
Mailing Address - Phone:703-938-6441
Mailing Address - Fax:703-319-3978
Practice Address - Street 1:407 CHURCH ST NE
Practice Address - Street 2:C
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4737
Practice Address - Country:US
Practice Address - Phone:703-938-6441
Practice Address - Fax:703-319-3978
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA036554Medicare ID - Type Unspecified
T30805Medicare UPIN